December 28, 2021
Recently, the Centers for Disease Control released updated isolation and quarantine guidelines in response to the Omicron variant and new data. The CDC now recommends, regardless of immunization status, that any individual who tests positive for Covid should isolate for five days (opposed to 10 days), and if asymptomatic or symptoms are resolving (fever must be resolved) that you can leave isolation if you wear a well-fitting mask when indoors or around others for five days.
If you were exposed to someone with Covid, and you are fully immunized (or boosted), a formal quarantine is not recommended, but it is recommended you wear a mask if around others and consider testing at day 5. If not boosted, not vaccinated, or it has been six months since you completed your immunization series, it is recommended that you formally quarantine at home for five days and then mask when around others for five additional days.
How do these guidelines affect return to sports?
The National Basketball Association (NBA) has shortened their isolation and quarantine durations based on the data and the recent guidelines. The NBA is shortening the quarantine period to six days, citing their own data that shows very few people are infections after five or six days. That quarantine can be shortened if players have two negative tests separated by 24 hours. Further, the NBA has reduced the isolation time for those who are fully vaccinated (and boosted) to five days for those who are asymptomatic and meet other testing standards.
College conferences have been quick to adjust to the new guidelines with the Southeastern Conference (SEC) stating that ahead of the College Football Playoff, they plan to adopt the new guidance proposed by the CDC. The Atlantic Coast Conference (ACC) also shortened their protocols based on initial CDC guidance for health care workers released earlier this week. They will allow asymptomatic, fully-vaccinated (boosted) athletes to clear isolation after two negative tests (separated by 24 hours); or if seven days have elapsed, symptoms are improving and they have a negative test within 24 hours (i.e. test on day 6, clear on day 7). It is unclear if the ACC will further modify their protocol, based on the more recent CDC recommendations.
The CDC updated guidance relies on “wearing a mask when around others” for days 6 through 10, which may be impractical in an athletic setting. Certainly, it is still recommended that to minimize spread and optimize the ability to participate, masks be worn in indoor group settings such as meetings, travel, social settings, and that social distancing be maintained during mealtimes. USCAH conversations with infectious disease specialists who have been advising conferences and organizations on sports during Covid, have recommended that, to return to play without masks, it is suggested an athlete has a negative Covid test on day 5 following a positive result. Within the infectious disease community, there remains concern about athletes returning at day five if unmasked and untested. It is recommended that prior to return to sport, you consult with your local medical staff to ensure a safe transition back to play. Finally, it is important, before implementation of your return to play protocol, that you consult with your local public health officials to ensure that you are consistent with local guidelines.
What does USCAH recommend?
USCAH recommends that fully boosted athletes who test positive be cleared from isolation on day 5 and allowed to participate unmasked if asymptomatic (or mild symptoms are improving without fever) AND a negative Covid test. Institutions or organizations with the resources could consider clearing athletes from isolation following two negative tests separated by 24 hours.
This could be performed via a rapid antigen test (if that rapid antigen test can detect omicron), or by a PCR or other nucleic acid amplification test. For those who are fully boosted (and date of last immunization was within six months), clearance from isolation can occur without testing at day 5, but masks should be worn when around others.
USCAH recommends that fully boosted people who are deemed a close contact do not need to quarantine but should mask and consider a test on day 5. Those that are not fully boosted, or unvaccinated, should formally quarantine for five days, then mask and distance when around others for five additional days.
Chad Asplund, MD, MPH
Executive Director, U.S. Council for Athletes' Health